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Update on Polymyalgia Rheumatica and Giant Cell Arteritis (Best of 2020)

Jack Cush, MD

JAMA has published a clinical update of recent studies on GCA. While PET/CT scanning are novel means of demonstrating activity, they have not changed the diagnostic approach to GCA or PMR and although there are no new proven treatment strategies for PMR beyond glucocorticoids, the FDA has approved tocilizumab as a first-line glucocorticoid-sparing agent. 

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ACR 2020 Reproductive Guidelines - Lactation Guidance (Best of 2020)

Jack Cush, MD

In this third excerpt from the ACR guidelines on managing reproductive health issues in rheumatic disease patients, we present recommendations regarding the use of glucocorticoids and guidance on lactation and medication use post-partum.

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COVID Risks in Systemic Autoimmune Patients

Jack Cush, MD

There have been conflicting reports of whether rheumatic patients have greater risks once they are infected with COVID-19. This claims cohort analysis suggests a mixed picture. 

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Mortality in Low Dose Prednisone

Eric Dein, MD

Upon release of the new ACR 2020 Pharmacologic Treatment Recommendations for the Management of Rheumatoid Arthritis, many practitioners were surprised that the new guidelines recommended against glucocorticoid initiation at disease onset.

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The tantalising prospect of glucocorticoid-free treatments for systemic vasculitis

Richard Conway, MBBChBAO, PhD

Glucocorticoids are a highly effective treatment in systemic vasculitis but are also a significant cause of long-term harm in the form of treatment related adverse events.

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What’s new in knee osteoarthritis that matters?

Janet Pope, MD, MPH, FRCPC

Are intra-articular steroid injections effective in symptomatic knee OA? Do they accelerate cartilage loss? Does weight less actually help? Do we have DMARDs for knee OA? Insights from 2020 ACR Convergence.

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RheumNow Podcast – ACR 2020 Epilogue (11.20.20)

Jack Cush, MD

Dr. Jack Cush reviews a few more ACR 2020 abstracts and presents a new plan to learn or take in ACR20 content.

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Ten-Year Analysis of Low-Dose Glucocorticoids in early RA

Meral K. El Ramahi, MD, FACP, FACR

Abstract #1998 by C. Roubille et al from Montpellier, France is a 10-year prospective analysis that looked at the risk of severe outcomes related to very low-dose glucocorticoid in early rheumatoid arthritis from the ESPOIR cohort.

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Study of 2050 Northern Italian arthritis clinic pts; where 1.1-1.4% of population developed COVID-19. Steroid use was independently associated with increased COVID risk (adj OR 1.23 to 3.20). But Rx w/ ts/bDMARDs had reduced risk (adj OR 0.46). https://t.co/cLXdpzda9t

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Dr. John Cush RheumNow ( View Tweet)

COVID: DMARDs, Steroids, a Vaccine - and how long will this continue? Dr. Winthrop reviews all things COVID-related including abstract L01, steroids and DMARDs, vaccination status - and how long this pandemic will last. #ACR20 https://t.co/KWq5ey5Kcf https://t.co/QKFZVnrMpD

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Dr. John Cush RheumNow ( View Tweet)
Check out our latest article from Richard Conway ( @RichardPAConway) #ACR20 The tantalising prospect of glucocorticoid-free treatments for systemic vasculitis https://t.co/VG1ah3Nq5c https://t.co/js3l527VHg

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Dr. John Cush RheumNow ( View Tweet)
#BestACR20Tweets RT @RichardPAConway :Dr Cid presents phase 2 trial of anti-GM-CSF agent mavrilimumab in combination with steroids in GCA. 70 patients. Sustained remission at week 26 in 83.2% of mavrilimumab vs 49.9% of placebo p=0.0038. @DrPujaMehta1 #ACR20 Abstr#L06 https://t.co/ynWbguXXzR
Dr. John Cush RheumNow ( View Tweet)
#BestACRTweets20 RT @RHEUMarampa : IgG4-RD tx: GCs are mainstay tx starting at 30-40mg/d tapered gradually but 30% of pts will have recurrences Potential therapeutic targets to ⬇GC toxicity ✏B cell/plasmablasts (promising) ✏T cells (anecdotal) #ACR20 https://t.co/htu849kng3

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Dr. John Cush RheumNow ( View Tweet)

"The tantalising prospect of glucocorticoid-free treatments for systemic vasculitis" by Dr. Richard Conway ( @RichardPAConway) https://t.co/VG1ah3Nq5c https://t.co/jORhfQn3EC

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Dr. John Cush RheumNow ( View Tweet)
Mortality in Low Dose Prednisone by Dr. Eric Dein ( @ejdein1). #ACR20 https://t.co/y6dL9V6iDC https://t.co/e7119ymgiq

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Dr. John Cush RheumNow ( View Tweet)
Read our news article "Ten-Year Analysis of Low-Dose Glucocorticoids in early RA" by Meral K. El Ramahi ( @MeralElRamahiMD) #ACR20. https://t.co/S9rOHc0864 https://t.co/6X4owP6pF0

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Dr. John Cush RheumNow ( View Tweet)
Quick Read! Mortality in Low Dose Prednisone by Dr. Eric Dein ( @ejdein1). #ACR20 https://t.co/y6dL9V6iDC https://t.co/ZFpxoTH07p

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Dr. John Cush RheumNow ( View Tweet)
Dr P Seo notes based on PEXIVAS study while PLEX does not seem to help with AAV, it showed you can drop steroid dose sooner: start pred 1 mg/kg/d but drop down after 1 week to 0.5 mg/kg/d #ACRReview #ACR20 @rheumnow

k dao KDAO2011 ( View Tweet)

Low-dose steroids in RA: what's the harm, right? (You probably know where I'm going with this) ESPOIR 10y data: total events, and severe infections worse with dose and time (cumulative 8.4g ≡ 5mg/d) No doubt some residual confounding, but real risk! #ACR20 ABST1998 @RheumNow https://t.co/BAQmOR1ped
David Liew drdavidliew ( View Tweet)
What would you use next? sero+ RA new keratitis requiring prednisone and now also 20 SJC. New rheumatoid nodules. Pt has been on triple csDMARDs + Leflunomide, then 2 JAKi and 2 TNFi also with MTX each time. All Rx works for 6 months then relapse. @RheumNow @CRASCRRheum https://t.co/9cTS1tNE42
Janet Pope Janetbirdope ( View Tweet)
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